[user1029384756]

Putting this out there in case it may help others: My mother suffered from GERD for years and years and about two years ago, her condition seemed to have taken a turn for the worse. We’re talking waking up in the middle of the night projectile vomiting. Constant heartburn, burping and indigestion after meals and daily constipation. The doctors were completely unable to help except to recommend antacids and possibly PPI medication which can have serious side-effects.

I put her on a prebiotic + probiotic diet (kaffir, yogurt, whole grains, dark leafy greens, etc) along with a basic probiotic supplement every night and now according to her, at least 95% of the symptoms have gone away. She’s able to sleep through the night now, better mood, better energy, better everything.

Not saying it will work for everyone, but it worked for her. I feel like so little is understood about the gut microbiome and modern medicine is letting people suffer needlessly.

Edit: just realized this sounds exactly like a paid infomercial lol

[lr4444lr]

Have you looked into sodium alginate supplements (with regard to reflux)? It's what got me back that last 5% you allude to after making all of the other lifestyle changes. An amazing product with no side effects. Also great for when regular life gets in the way of being able to adhere to the diet.

[user1029384756]

No I’ve never heard of this, thanks for the tip. I’ll definitely be checking this out.

[froh]

soo _this_ is the paid informational part ;-) ?

[selectodude]

I had all those symptoms and it turned out to be gallstones.

[fastball]

Do doctors not routinely recommend pre/probiotics to replenish gut microbiota these days? I've had multiple discussions with medical professionals that would indicate they are on board with the idea. To whit, I had to take strong oral antibiotics for a serious bacterial throat infection I had last year, and afterwards saw a significantly diminished ability to cope with spicy foods (I love spicy food). The doctor suggested probiotics and that seemed to help a lot.

Interestingly, the body of research around fermented foods (kefir [sic], yogurt, kimchi, etc) seems to show more robust benefits than probiotic supplements[1].

[1] https://www.cell.com/cell/fulltext/S0092-8674(21)00754-6

[astrange]

Each probiotic is different and each person is different, so it's hard to make the recommendation actionable.

You'd have to know what's already in your intestines, and the best we have are poop tests, one of which (uBiome, YC S14) famously failed and is being prosecuted as insurance fraud, so doctors probably don't want to get into that. (There are still going ones like Viome that might give you interesting results.)

Fermented foods aren't all the same too; yogurt is milder than kimchi for sure.

[unsupp0rted]

What are the side-effects for PPIs? I've been taking them for almost 2 decades for GERD without anything too specific coming up.

I check my B12 levels from time to time and they seem ok.

My hemoglobin is always a bit low and iron supplements don't seem to help.

What other things are common with long-term PPI use?

[user1029384756]

I am not in any way shape or form a medical professional, but there do seem to be some studies that show there is evidence of an increased risk of gastric cancer with long term PPI use. Again, not a medical professional, so if it works for you and suits your personal risk tolerance, please don’t let a random internet commenter freak you out.

[lg]

Lowering stomach acid can throttle calcium absorption so is linked to osteoporosis but i don’t know how common that is in practice.

[piyh]

Can also lower iron absorption

[kryz]

Higher concentrations of oral bacteria detected in the gut of people who use PPIs. That can’t be a good thing…

[myshpa]

Have you tried apple cider vinegar (ACV)? Works wonders.

PPIs don't really treat GERD, imho it's one of those medicines to be used perpetually (good only for shareholders).

https://www.youtube.com/watch?v=qTzxfoL82n8 - good explanation why/how ACV works and why PPIs don't, iirc

[unsupp0rted]

I was told me esophageal sphincter doesn't fully close. Would apple cider vinegar help keep my acid low?

[jnellis]

If you are overweight or have belly fat then it may be that your esophageal sphincter is fine and its your sleeping position that is causing the issue. Sleeping on your stomach causes belly fat to push into the area of your sphincter and opens it up slightly, now acids can flow past this point. The rise of esophageal cancer in the 90's up to now corresponds with the rise of obesity. I was actually allergic to NSAIDs which were causing gastritis but this mechanical component of sleeping on stomach (and being fatter at the time) was one of the issues that made it worse. After losing some weight it went away and after figuring out NSAIDs were causing the initial problem, I've been reflux free for four years now. Spent twenty years battling this problem and thought most of it was due to hereditary reason because my father had the same issues and died from esophageal cancer.

[unsupp0rted]

These are good points and hopefully useful to other HNers.

I'm not overweight by more than a kilo or two, and I sleep on my back or side, so this doesn't match my case as much.

[lr4444lr]

It will exacerbate esophageal irritation on the way down even if it did help a weak LES (which it doesn't). Please ask your doctor before trying this. Avoiding unadulterated high acid foods is a first line treatment for gastric problems.

[unsupp0rted]

Yup, no coffee / dark chocolate / dairy / alcohol / citrus for me for over a decade now, among other things. I don't miss any of it, except chocolate milk.

I've seen vinegar recommended for GERD online before, but was curious whether there's much medical know-how behind it (studies or at least a clear theory of why it would help me vs. PPIs).

With a weak LES (lower esophageal sphincter) a lot of "just do this" GERD folk remedies don't work.

[lr4444lr]

The "theory" behind ACV is that stomach problems can be caused by H. Pylori overgrowth due to acid underproduction. H. Pylori and stomach acidity problems are easily testable diagnoses via upper endoscopy on a case by case basis. What is NOT controversial however is the much higher vulnerability of the esophagus to acid (on the way up or the way down), pain from which damage is the "burn" in heartburn. The esophagus needs time to heal regardless of whether ACV would or would not help the stomach, and it'd definitely be harmful to the inflamed tissue up there. As I mentioned above, sodium alginate is a remarkably effective and safe treatment for mild and moderate GERD, which is picking up interest as PPIs are coming under intense scrutiny for possible harmful side effects long term. It's not a cure to anything per se, but this isn't medical advice either - people should root cause their stomach troubles with a qualified doctor.

[debacle]

The goal isn't to keep your acid low it's to keep your stomach moving.

If you have low acid your digestion will be slower and if it's low enough you will develop bacterial infections. PPIs lower your stomach acid and can cause long term issues.

1/2 tablespoon in a large glass of water. Do not drink cider vinegar straight up. It will burn you. Literally.

[myshpa]

"When you look at the data, blaming GERD on too much stomach acid doesn’t make sense. Stomach acid actually tends to decline, not rise, with age, while GERD risk increases with age. (4) In fact, 40-year-olds, on average, generate about half as much as stomach acid as 20-year-olds do. And, according to one study, over 40 percent of people age 80 and up may be producing almost no stomach acid at all."[4]

This condition is called https://en.wikipedia.org/wiki/Achlorhydria , and one of known side-effects of that is gastroesophageal reflux disease.

"The ideal pH for the stomach can approach 1 but should be below 3, where most pathogens cannot survive. When the pH rises above 5, several dangerous bacterial species are able to survive. Acid-blockers can increase the stomach’s pH ..."[4]

For lower esophageal sphincter to properly work, you in fact need normal levels of acid and proper acidity.[0][1][2][3] If you have the oposite, the sphincter does not fully close and boom, there's your heart burn.

The real mechanism of gerd is more complicated than "too much acid" or "acid too strong". I don't suggest you start drinking unwatered vinegar. I suggest you study the sources I've linked and only then decide for youself.

> I've seen vinegar recommended for GERD online before, but was curious whether there's much medical know-how behind it (studies or at least a clear theory of why it would help me vs. PPIs).

[0] https://www.youtube.com/watch?v=qTzxfoL82n8

[1] https://www.youtube.com/watch?v=HhUTAw6wcK8

[2] https://www.youtube.com/watch?v=nkRrlJFDFdA

[3] https://www.youtube.com/watch?v=i_UWDPrDR40

[4] https://chriskresser.com/how-to-cure-gerd-without-medication...

[5] https://en.wikipedia.org/wiki/Achlorhydria

[rswail]

It would be interesting to know what her diet was like before you radically changed it.

In other words, changing to what appears to be a more healthy diet (fermented food, high fibre and high nutrient vegetables etc) might have worked with or without the probiotic side of things.

I definitely agree that the connection between our gut and our health/behavior is going to be a very fruitful area of reasearch over the next 5-10 years.

[voxl]

Any time GERD comes up diet is one of the very first things people are told about (by doctors) to reduce symptoms.

[mrcode007]

I was a long time sufferer until I came across a doctor who correctly diagnosed me with antibiotic resistant chronic h.pylori infection that lead to inflammation of a stomach lining. The test was painless and consisted of capturing air you breathe out into a special bag. After treatment I am symptom free. The antibiotic regimen I went through was the worst I’ve ever experienced due to resistance.

[user1029384756]

Before the current home-brewed protocol she tried many different things and many different diets that didn’t work, and was told by the doctor there wasn’t much he could do since it had to do with a weak/loose LES.

[pfdietz]

And the next thing is proton pump inhibitors. They work marvelously, but you develop a dependency on them.

[ycombinete]

I think you mean Kefir. "Kaffir" is a racial slur in South Africa, derived from the Arabic "Kafir" for non-believer [0].

[0] https://en.wikipedia.org/wiki/Kaffir_(racial_term)

[aszantu]

you might want to supplement with gelatine to help rebuild anything that was damaged by the acid.

I was suffering from reflux, switched to mostly carnivore diet and only get heartburn now when I eat or drink the wrong things. Tea does that to me, or the occasional piece of bread.

Also Depression went away, haven't done any gut micro biota testing, because it's expensive and I'm not rich.

[geysersam]

Could you please point us to more information about this?

My girlfriend suffers from similar symptoms (but less severe).

[user1029384756]

Note: I’m not a healthcare professional so please take anything I say with a grain and salt and be sure to do your own doctor consultations + research. This should not be taken as medical advice, its just what has been working in our case.

@myshpa posted a link above which I hadn’t seen before, that actually confirms many of my own independent observations: https://chriskresser.com/how-to-cure-gerd-without-medication...

What worked for her:

- 10-15 minutes before every meal, suck on a DGL (Deglycyrrhizinated Licorice) tablet. This will interact with saliva and cause the GI system to secrete mucus to protect itself from acid.

- During the meal, take a digestive enzyme that contains at least Betaine HCL, Bromelain and Papain which will help break down carbs and proteins and stop food from entering the gut half digested, which can cause gas production from fermentation.

- Take a probiotic supplement every night before bed (we’ve found 15 billion to be sufficient, but you can try ones that are less/more potent). If you need water to swallow, squirt a tiny bit of lemon juice into it first.

Diet-wise: Avoid things that will relax the LES such as caffeine, mint, chocolate, etc. Avoid anything with tomato skins and certain types of legumes (if you want to eat these, remove the skins). It can be difficult, but reduce sugar intake as much as possible. Try not to drink water while eating (it will dilute stomach acid) but if she needs to, its been my observation that a tiny squirt of lemon juice with water helps.

Eat fermented foods regularly like Kefir, Kimchi, Sauerkraut, yogurt, etc. These probiotics will need to consume fibre from prebiotics in order to not starve in the gut. Increase your intake of all kinds of high fibre whole foods. Kale, beans, broccoli, whole grains, potatoes, whole almonds, etc. Google “low FODMAP diet”.

Regular exercise is important. It can be something low intensity like walking. It helps stimulate the digestive system and gut activity. Do it before meals, preferably.

It can be counterintuitive, but I think the root cause of a lot of GERD symptoms is actually weak stomach acid. That article linked above summarizes it pretty nicely. If that’s the case, make sure your girlfriend is at least supplementing with vitamins C and D, plus a B-complex with Methylcobalamine. Low stomach acid can cause malabsorption of these nutrients and others.

Keep a log book. Every body is different, so every time there is an episode, be sure to record what was specifically eaten that day and then avoid that food.

Any other questions feel free to ask.

[corobo]

Sounds less paid infomercial and a little closer to antivax from here if I'm honest.

Did she at least tell the doctor "hey no worries my kid fixed it"? What did they say?

[user1029384756]

I guess the difference is that being an antivaxer can potentially harm society whereas trying a high fibre, probiotic rich diet can’t hurt anyone. And I completely understand the skepticism, which is why I couched my comment with “it may not work for everyone”.

> Did she at least tell the doctor "hey no worries my kid fixed it"? What did they say?

The answer is no: I told her not to tell her doctor under any circumstances that she got armchair advice from her “kid” that actually worked because if I was a doctor who went through 10 years of med school + training, I would definitely be rolling my eyes if some senior came in and told me this story.

The point is, I haven’t dropped any probiotic brand names, I’m not hawking anything, I don’t gain anything by posting my little anecdotal experience. I’m just happy that I found a solution to a problem that has been torturing someone I care about for 10-15 years and wanted to share it so that it might help others in the same situation.

Edit: to be clear, there were other things too that helped clear up her symptoms that I omitted because my post was getting too long and because out of everything, probiotics seemed to be the biggest gamechanger. For example: first few months she also took DGL (Deglycyrrhizinated Licorice, to promote mucus secretion) 15 minutes before every meal, followed by a digestive enzyme taken with the meal (she doesn’t actually need these anymore and only takes it as a precaution if the meal is particularly starchy or high protein). Cutting out LES relaxers like caffeine, mint and chocolate helped. Also lifestyle changes were made in terms of physical activity. She still needs to sleep at an incline on a wedge block, but at least she’s not vomiting all over the carpet anymore.

[nwienert]

Be careful, autoimmune conditions can affect the stomach and present symptoms similar to IBS, GERD, including projectile vomiting after eating. I know because I had that for years, but it was cyclical. Every time I thought I had it beat due to (insert 10 things I was trying at the time) it would come back with vengeance. Eventually it just went away but by then I had no illusion that I had done anything.

Turns out it was Familial Mediterranean Fever and it just goes away in your early 20s. I was never diagnosed until many years later and I even thought a lot of my remedies maybe worked until then.

Digestive and autoimmune both are labyrinthine in potential problems and misdiagnoses.

[user1029384756]

> Digestive and autoimmune both are labyrinthine in potential problems and misdiagnoses.

No argument there, and I appreciate the warning. It definitely gives me no pleasure playing doctor and I’m very conscious of the risk of giving misleading medical advice.

The reason why I’m confident enough to post this is that it has already been more than a year now since the major symptoms went away. The effect of the probiotics was/is pretty definitive (she recently stopped taking them for about a week while on vacation and the symptoms started slowly creeping back, and disappeared again shortly after resuming). Also, there is pretty much no real alternative treatment aside from PPIs or physical LES surgery anyway. If there is indeed an underlying autoimmune condition though, I can’t see how this diet could hurt too much. But maybe that’s due to ignorance.

I’m so happy you overcame that hell.

[corobo]

Well as long as you're omitting information for brevity while suggesting it may be helpful to others and at the same time having told n=1 to avoid consulting with someone who is trained in the subject that may be able to catch and correct any errors or problems you've missed I can't see any issue there. I stand corrected.

[user1029384756]

This course of action was only taken after consultations with trained professionals had already failed and as I mentioned, the effect of the omitted supplements paled in comparison with the probiotics. Also this is a thread about gut bacteria so I thought I’d initially only mention the most relevant part of the treatment and follow-up if there was more interest.

It’s pretty clear that this (like 99% of internet advice) is all anecdotal evidence and again, I’ve made it clear it may not work for everyone. I’ve also mentioned elsewhere that I’m not a healthcare professional. But if my comment is able to help even one person escape the nightmare of not being able to hold food down and the sleep deprivation and depression that comes with severe GERD… then that’s worth one snarky linux systems guy yelling at me on HN.

:)